R8) Patient presenting for breast cancer screening

Review the Learning Outcomes, Hx, PE and Labs, and begin the module with your Provisional Diagnosis. Keep hitting "Next" to move through the module.

Learning Outcomes

  1. Articulate your relationship with the consulting diagnostic radiologists in the evaluation of a patient with a breast mass.
  2. Review the DDx considerations in a breast mass.
  3. Identify the spectrum of imaging findings in appropriate modalities for evaluating patients with a breast mass.

History

Physical Exam

Labs

Provisional Diagnosis

Select the Dx you believe is most appropriate
Not applicable - This module pertains to breast cancer screening and does not involve a provisional diagnosis.
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Potential Acuity

What is your assessment of the likely acuity for this patient?

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This patient requires routine workup.

First Imaging Study

What is the first imaging study you will order?

The USPTF recommends screening mammography for women ages 40 to 74 years every two years.
View ACR Appropriateness Criteria
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Pertinent Imaging Observations

Click on the links below to view images from the study, and assess these key findings as best you can.

View Report

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View the full study if you'd like to take a look yourself.

Second Imaging Study

What is the next imaging study you will order?

Given that the initial screening mammogram is considered incomplete due to the detection of a spiculated mass, further detailed imaging is required. Either a diagnostic mammogram or breast ultrasound providing more detailed imaging of the area of concern may be obtained.
View ACR Appropriateness Criteria
Well done. You were correct

Pertinent Imaging Observations

Click on the links below to view images from the study, and assess these key findings as best you can.

View Report

Watch our video

View the full study if you'd like to like a look yourself

Third Imaging Study

What is the next imaging study you will order?

No further imaging is necessary.

What is your Diagnosis now that you have seen the imaging results?

The lesion characteristics are concerning for a malignant lesion, such as invasive ductal carcinoma.

Current Acuity

Initially, you selected and we suggested acuity.

Has your concern for this patient changed?

This patient requires routine management.

Assessment and Plan

Please provide your assessment and plan for this patient

This patient is a 60-year-old female who underwent a screening mammography, which demonstrated a breast mass with malignant characteristics. A biopsy is recommended for definitive diagnosis, and referral to a multidisciplinary oncology team should be initiated. Depending on the biopsy results, tumor grade, and hormone receptor status, treatment strategies including surgery (lumpectomy or mastectomy), radiation therapy, chemotherapy, hormonal therapy, or targeted therapy will be considered.

Lessons Learned:
- As of 2023, The United States Preventive Services Task Force (USPSTF) recommends regular screening mammography for women between the ages of 40 and 74, with a frequency of once every two years.
- A palpable mass is often the primary symptom of breast cancer. Furthermore, palpable cancers tend to exhibit aggressive behavior and have a less favorable prognosis compared to cancers detected through regular screening.
- For women over 40, a diagnostic mammogram is the recommended initial imaging technique for evaluating a palpable breast mass. In cases where there is uncertainty regarding the correlation between the mammographic finding and the palpable lesion, a targeted ultrasound can be used as a secondary study.
- Mammographic features that may suggest malignancy include irregular masses, spiculation, and the presence of microcalcifications.
- Ultrasound features that may suggest malignancy include ill-defined, hypoechoic masses, hyperechoic angular margins, posterior acoustic shadowing, posterior enhancement, a branched or spiculated pattern, being “taller than broader,” and the presence of microcalcifications.

Socioeconomic Factors: Women with higher socioeconomic status show significantly higher breast cancer incidence, which may be explained by reproductive factors, mammography screening, hormone replacement therapy and lifestyle factors.

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